St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CHG CYTP INSITU HYBRID URNE SPEC 3-5 PROBES CPTR EA

Professional

Both

$1,785.14

Service Code	HCPCS 88121
Min. Negotiated Rate	$1,338.86
Max. Negotiated Rate	$1,338.86
Rate for Payer: Cash Price	$490.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,338.86
Rate for Payer: SOMOS Essential	$1,338.86

CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V

Professional

Both

$172.38

Service Code	HCPCS 88112 TC
Min. Negotiated Rate	$129.28
Max. Negotiated Rate	$129.28
Rate for Payer: Cash Price	$48.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$129.28
Rate for Payer: SOMOS Essential	$129.28

CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V

Professional

Both

$278.29

Service Code	HCPCS 88112
Min. Negotiated Rate	$208.72
Max. Negotiated Rate	$208.72
Rate for Payer: Cash Price	$78.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$208.72
Rate for Payer: SOMOS Essential	$208.72

CHG CYTP SLCTV CELL ENHANCEMENT INTERPJ XCPT C/V

Professional

Both

$105.95

Service Code	HCPCS 88112 26
Min. Negotiated Rate	$79.46
Max. Negotiated Rate	$79.46
Rate for Payer: Cash Price	$29.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$79.46
Rate for Payer: SOMOS Essential	$79.46

CHG CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES

Professional

Both

$347.59

Service Code	HCPCS 88162 TC
Min. Negotiated Rate	$260.69
Max. Negotiated Rate	$260.69
Rate for Payer: Cash Price	$107.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$260.69
Rate for Payer: SOMOS Essential	$260.69

CHG CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES

Professional

Both

$151.10

Service Code	HCPCS 88162 26
Min. Negotiated Rate	$113.32
Max. Negotiated Rate	$113.32
Rate for Payer: Cash Price	$41.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$113.32
Rate for Payer: SOMOS Essential	$113.32

CHG CYTP SMRS ANY OTH SRC EXTND STD > 5 SLIDES

Professional

Both

$498.72

Service Code	HCPCS 88162
Min. Negotiated Rate	$374.04
Max. Negotiated Rate	$374.04
Rate for Payer: Cash Price	$149.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$374.04
Rate for Payer: SOMOS Essential	$374.04

CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ

Professional

Both

$98.42

Service Code	HCPCS 88161 26
Min. Negotiated Rate	$73.82
Max. Negotiated Rate	$73.82
Rate for Payer: Cash Price	$26.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$73.82
Rate for Payer: SOMOS Essential	$73.82

CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ

Professional

Both

$225.40

Service Code	HCPCS 88161 TC
Min. Negotiated Rate	$169.05
Max. Negotiated Rate	$169.05
Rate for Payer: Cash Price	$67.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$169.05
Rate for Payer: SOMOS Essential	$169.05

CHG CYTP SMRS ANY OTH SRC PREPJ SCR&INTERPJ

Professional

Both

$323.82

Service Code	HCPCS 88161
Min. Negotiated Rate	$242.86
Max. Negotiated Rate	$242.86
Rate for Payer: Cash Price	$94.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$242.86
Rate for Payer: SOMOS Essential	$242.86

CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ

Professional

Both

$216.79

Service Code	HCPCS 88160 TC
Min. Negotiated Rate	$162.59
Max. Negotiated Rate	$162.59
Rate for Payer: Cash Price	$65.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$162.59
Rate for Payer: SOMOS Essential	$162.59

CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ

Professional

Both

$316.65

Service Code	HCPCS 88160
Min. Negotiated Rate	$237.49
Max. Negotiated Rate	$237.49
Rate for Payer: Cash Price	$92.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$237.49
Rate for Payer: SOMOS Essential	$237.49

CHG CYTP SMRS ANY OTH SRC SCR&INTERPJ

Professional

Both

$99.86

Service Code	HCPCS 88160 26
Min. Negotiated Rate	$74.90
Max. Negotiated Rate	$74.90
Rate for Payer: Cash Price	$27.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$74.90
Rate for Payer: SOMOS Essential	$74.90

CHG DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I

Professional

Both

$58.87

Service Code	HCPCS 70170 26
Min. Negotiated Rate	$44.15
Max. Negotiated Rate	$44.15
Rate for Payer: Cash Price	$16.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44.15
Rate for Payer: SOMOS Essential	$44.15

CHG DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I

Professional

Both

$252.95

Service Code	HCPCS 70170
Min. Negotiated Rate	$189.71
Max. Negotiated Rate	$189.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$189.71
Rate for Payer: SOMOS Essential	$189.71

CHG DACRYOCSTOGRAPY NASOLACRIMAL DUCT RS&I

Professional

Both

$194.08

Service Code	HCPCS 70170 TC
Min. Negotiated Rate	$145.56
Max. Negotiated Rate	$145.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$145.56
Rate for Payer: SOMOS Essential	$145.56

CHG DARK FIELD EXAM ANY SOURCE W/SPECIMEN COLLECTION

Professional

Both

$74.97

Service Code	HCPCS 87164 26
Min. Negotiated Rate	$56.23
Max. Negotiated Rate	$56.23
Rate for Payer: Cash Price	$20.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$56.23
Rate for Payer: SOMOS Essential	$56.23

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+

Professional

Both

$237.65

Service Code	HCPCS 71270 26
Min. Negotiated Rate	$178.24
Max. Negotiated Rate	$178.24
Rate for Payer: Cash Price	$64.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$178.24
Rate for Payer: SOMOS Essential	$178.24

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+

Professional

Both

$865.59

Service Code	HCPCS 71270
Min. Negotiated Rate	$649.19
Max. Negotiated Rate	$649.19
Rate for Payer: Cash Price	$233.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$649.19
Rate for Payer: SOMOS Essential	$649.19

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+

Professional

Both

$627.90

Service Code	HCPCS 71270 TC
Min. Negotiated Rate	$470.92
Max. Negotiated Rate	$470.92
Rate for Payer: Cash Price	$169.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$470.92
Rate for Payer: SOMOS Essential	$470.92

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST

Professional

Both

$733.57

Service Code	HCPCS 71260
Min. Negotiated Rate	$550.18
Max. Negotiated Rate	$550.18
Rate for Payer: Cash Price	$198.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$550.18
Rate for Payer: SOMOS Essential	$550.18

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST

Professional

Both

$510.02

Service Code	HCPCS 71260 TC
Min. Negotiated Rate	$382.52
Max. Negotiated Rate	$382.52
Rate for Payer: Cash Price	$137.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$382.52
Rate for Payer: SOMOS Essential	$382.52

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST

Professional

Both

$223.51

Service Code	HCPCS 71260 26
Min. Negotiated Rate	$167.63
Max. Negotiated Rate	$167.63
Rate for Payer: Cash Price	$60.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$167.63
Rate for Payer: SOMOS Essential	$167.63

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST

Professional

Both

$582.79

Service Code	HCPCS 71250
Min. Negotiated Rate	$437.09
Max. Negotiated Rate	$437.09
Rate for Payer: Cash Price	$157.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$437.09
Rate for Payer: SOMOS Essential	$437.09

CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST

Professional

Both

$375.06

Service Code	HCPCS 71250 TC
Min. Negotiated Rate	$281.30
Max. Negotiated Rate	$281.30
Rate for Payer: Cash Price	$101.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$281.30
Rate for Payer: SOMOS Essential	$281.30

Know your out-of-pocket cost for care.

All Charges